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1.
BMC Public Health ; 22(1): 1560, 2022 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-35974367

RESUMO

BACKGROUND: Cognitive decline can be an early indicator for dementia. Using quantitative methods and national representative survey data, we can monitor the potential burden of disease at the population-level. METHODS: BRFSS is an annual, nationally representative questionnaire in the United States. The optional cognitive decline module is a six-item self-reported scale pertaining to challenges in daily life due to memory loss and growing confusion over the past twelve months. Respondents are 45+, pooled from 2015-2020. Latent class analysis was used to determine unobserved subgroups of subjective cognitive decline (SCD) based on item response patterns. Multinomial logistic regression predicted latent class membership from socio-demographic covariates. RESULTS: A total of 54,771 reported experiencing SCD. The optimal number of latent classes was three, labeled as Mild, Moderate, and Severe SCD. Thirty-five percent of the sample belonged to the Severe group. Members of this subgroup were significantly less likely to be older (65+ vs. 45-54 OR = 0.29, 95% CI: 0.23-0.35) and more likely to be non-Hispanic Black (OR = 1.80, 95% CI: 1.53-2.11), have not graduated high school (OR = 1.60, 95% CI: 1.34-1.91), or earned <$15K a year (OR = 3.03, 95% CI: 2.43-3.77). CONCLUSIONS: This study determined three latent subgroups indicating severity of SCD and identified socio-demographic predictors. Using a single categorical indicator of SCD severity instead of six separate items improves the versatility of population-level surveillance.


Assuntos
Disfunção Cognitiva , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Disfunção Cognitiva/epidemiologia , Humanos , Análise de Classes Latentes , Transtornos da Memória , Autorrelato , Estados Unidos/epidemiologia
2.
Arch Phys Med Rehabil ; 102(7): 1347-1351, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33689694

RESUMO

OBJECTIVE: To examine use, costs, and value of physical therapy (PT) among subgroups. DESIGN: We conducted an observational study of data from a randomized trial of a pain coping skills intervention. Good and poor outcome subgroups were determined based on Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) Pain and Physical Function scores. The use and costs of PT care as well as changes in WOMAC Pain and Physical Function scores over 4 time periods during a 1-year follow-up were reported. We compared the number of PT visits, total PT costs, and cost per 1-unit improvement in WOMAC scores for the 2 latent subgroups. SETTING: Five academic medical centers. PARTICIPANTS: Patients who catastrophized about their pain prior to knee arthroplasty (N=384). INTERVENTIONS: Pain coping skills training, arthritis education, and usual care. MAIN OUTCOME MEASURES: The WOMAC Pain Scale was the primary outcome. RESULTS: The value of PT was lower and the cost of PT was higher for poor vs good outcome subgroups beginning 2 months after knee arthroplasty. For example, during the 2- to 6-month period, participants in the poor outcome subgroup incurred a PT cost of $5181.22 per 1-unit improvement in WOMAC Pain compared with $437.87 per 1-unit improvement in WOMAC Pain for the good outcome subgroup (P<.001). From the 6- to 12-month period, WOMAC scores worsened for the poor outcome subgroup, indicating no benefit from PT. CONCLUSIONS: Patients in 2 latent classes demonstrated clinically important differences in value of PT. Future research should identify rehabilitation-based interventions that reduce utilization and enhance effectiveness for patients at high risk for poor outcome.


Assuntos
Adaptação Psicológica , Artroplastia do Joelho/psicologia , Artroplastia do Joelho/reabilitação , Catastrofização/psicologia , Modalidades de Fisioterapia/economia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor
3.
Public Health Nutr ; 23(15): 2781-2792, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32713394

RESUMO

OBJECTIVE: Economic hardship (EH) may link to poorer child diet, however whether this association is due to resource limitations or effects on family functioning is unknown. This study examines whether parenting stress mediates the association between EH and child consumption of foods high in saturated fats and added sugars (SFAS). DESIGN: Data were collected from the Fragile Families and Child Wellbeing study. EH was assessed using eight items collected when children were between 1-9 years old. Mothers reported parenting stress and frequency of child consumption of high SFAS foods when children were 9 years old. Latent growth curve modelling (LGCM) and structural equation modelling tested direct associations between the starting level/rate of change in EH and high SFAS food consumption, and parenting stress as a mediator of the association. SETTING: Twenty US cities. PARTICIPANTS: Mothers/children (n 3846) followed birth through age 9 years, oversampled 'high-risk', unmarried mothers. RESULTS: LGCM indicated a curvilinear trend in EH from ages 1-9, with steeper increases from ages 3-9 years. EH did not directly predict the frequency of high SFAS foods. Average EH at 3 and 5 years and change in EH from ages 1-9 predicted higher parenting stress, which in turn predicted more frequent consumption of high SFAS foods. CONCLUSIONS: Findings suggest it may be important to consider parenting stress in early prevention efforts given potential lasting effects of early life EH on child consumption of high SFAS foods. Future research should explore how supports and resources may buffer effects of EH-related stress on parents and children.


Assuntos
Gorduras na Dieta/administração & dosagem , Açúcares da Dieta/administração & dosagem , Ácidos Graxos/administração & dosagem , Poder Familiar , Pobreza , Estresse Psicológico , Criança , Pré-Escolar , Feminino , Alimentos , Humanos , Lactente , Mães
4.
BMC Public Health ; 20(1): 1676, 2020 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-33167949

RESUMO

BACKGROUND: Neighborhood poverty may increase childhood obesity risk. However, evidence for the neighborhood poverty-obesity relationship is limited. The purpose of this study was to examine how moving to a higher or lower poverty neighborhood impacts body mass index (BMI) z-score trajectories among youth, with the goal of informing policy change, interventions, and clinical practices to reduce childhood obesity. METHODS: Methods entailed secondary analysis of existing longitudinal data. The sample included youth attending New York City public schools in grades kindergarten through twelfth from school years 2006/2007 through 2016/2017. Eligibility criteria included moving to a higher or lower poverty neighborhood during the data midpoint [school years 2010/2011 through 2013/2014] of the 12-year data-period; New York City-specific metrics were used to define both neighborhood (Neighborhood Tabulation Area) and relevant neighborhood poverty levels (< 5, 5 to < 10%, 10 to < 20%, 20 to < 30%, 30 to < 40% and ≥ 40% of individuals below Federal Poverty Level). Two-piece latent growth curve models were used to describe BMI z-score trajectories of youth who moved to higher versus lower poverty neighborhoods, with propensity score weighting to account for preexisting differences between the two groups. Primary analyses were stratified by sex and exploratory subgroup analyses were stratified by sex and developmental stage (early childhood, middle childhood, and adolescence) to explore sensitive periods for neighborhood poverty exposure. RESULTS: Of 532,513 youth with home address data, 18,370 youth moved to a higher poverty neighborhood and 19,174 moved to a lower poverty neighborhood (n = 37,544). Females and males who moved to a higher poverty neighborhood experienced less favorable BMI z-score trajectories for obesity risk, though effects were small. Exploratory subgroup analyses demonstrated that negative effects of neighborhood poverty were most pronounced among young and adolescent females and young males, whereas effects were mixed for other subgroups. CONCLUSIONS: Youth who moved to higher poverty neighborhoods experienced less favorable BMI z-score trajectories for obesity risk, though effects were small and most consistent for females and younger youth. Additional research is needed to illuminate neighborhood poverty's impact on obesity, in order to inform policy, intervention, clinical, and research efforts to reduce obesity and improve child well-being.


Assuntos
Pobreza , Características de Residência , Adolescente , Índice de Massa Corporal , Criança , Pré-Escolar , Feminino , Humanos , Estudos Longitudinais , Masculino , Cidade de Nova Iorque/epidemiologia
5.
BMC Musculoskelet Disord ; 21(1): 604, 2020 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-32912169

RESUMO

A recently published paper by te Molder and colleagues in BMC Musculoskeletal Disorders confirmed prior reports indicating that definitions of good versus poor outcome cutoff scores for relevant knee arthroplasty outcomes including pain and function are heterogeneous and that this heterogeneity prevents generalizable inferences. In this Correspondence, we highlight an additional and, in our view, a more important problem with the substantial literature on this topic. There also is high homogeneity in that all studies relied on arbitrarily defined cutoff scores to differentiate good versus poor outcome. We discuss this problem and propose a method to avoid repeating the same problem in future studies designed to group patients into those with good versus those with poor outcome following knee arthroplasty.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Artroplastia do Joelho/efeitos adversos , Humanos , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/cirurgia , Dor/cirurgia , Medição da Dor , Resultado do Tratamento
6.
Qual Life Res ; 28(6): 1605-1614, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30684148

RESUMO

PURPOSE: Mattering to others, or perceiving one is a significant part of the social world, may be important to breast cancer survivors' quality of life. This study examines the reliability and validity of the 5-item general mattering scale (GMS) to assess mattering in breast cancer survivors. METHODS: A secondary analysis and confirmatory factor analysis (CFA) were performed on data from an intervention study with breast cancer survivors that included the GMS and other psychological measures. RESULTS: The unidimensional representation of the GMS was consistent with the data (χ2 = 8.102; df = 4; p = .088). The scale was highly reliable as indicated by McDonald's omega of .84. The scale was significantly correlated with all psychological measures in the predicted direction except anxiety. After controlling for social support, the scale was significantly, positively correlated with functional quality of life, self-esteem, positive affect, and having meaning in life. Mattering was significantly, negatively correlated with searching for meaning. Significantly higher level of mattering was found among married participants and among women who had not obtained psychological therapy. CONCLUSIONS: The 5-item GMS is a practical, reliable, and valid tool the measuring mattering to others among breast cancer survivors.


Assuntos
Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Psicometria/métodos , Qualidade de Vida/psicologia , Adulto , Idoso , Neoplasias da Mama/mortalidade , Feminino , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto Jovem
10.
Clin Orthop Relat Res ; 476(4): 778-786, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29543659

RESUMO

BACKGROUND: Pain-coping strategies and appraisals are responses to the pain experience. They can influence patient-reported and physical performance outcome measures in a variety of disorders, but the associations between a comprehensive profile of pain-coping responses and preoperative pain/function and physical performance measures in patients scheduled for knee arthroplasty have not been examined. Patients with moderate to high pain catastrophizing (a pain appraisal approach associated with an exaggerated focus on the threat value of pain) may represent an excellent study population in which to address this knowledge gap. QUESTIONS/PURPOSES: We asked the following questions among patients with high levels of pain catastrophizing who were scheduled for TKA: (1) Do maladaptive pain responses correlate with worse self-reported pain intensity and function and physical performance? (2) Do adaptive pain-coping responses show the opposite pattern? As an exploratory hypothesis, we also asked: (3) Do maladaptive responses show more consistent associations with measures of pain, function, and performance as compared with adaptive responses? METHODS: A total of 384 persons identified with moderate to high levels of pain catastrophizing and who consented to have knee arthroplasty were recruited. The sample was 67% (257 of 384) women and the mean age was 63 years. Subjects were consented between 1 and 8 weeks before scheduled surgery. All subjects completed the WOMAC pain and function scales in addition to a comprehensive profile of pain coping and appraisal measures and psychologic health measures. Subjects also completed the Short Physical Performance Battery and the 6-minute walk test. For the current study, all measures were obtained at a single point in time at the preoperative visit with no followup. Multilevel multivariate multiple regression was used to test the hypotheses and potential confounders were adjusted for in the models. RESULTS: Maladaptive pain responses were associated with worse preoperative pain and function measures. For example, the maladaptive pain-coping strategy of guarding and the pain catastrophizing appraisal measures were associated with WOMAC pain scores such that higher guarding scores (ß = 0.12, p = 0.007) and higher pain catastrophizing (ß = 0.31, p < 0.001) were associated with worse WOMAC pain; no adaptive responses were associated with better WOMAC pain or physical performance scores. Maladaptive responses were also more consistently associated with worse self-reported and performance-based measure scores (six of 16 associations were significant in the hypothesized direction), whereas adaptive responses did not associate with better scores (zero of 16 scores were significant in the hypothesized direction). CONCLUSIONS: The maladaptive responses of guarding, resting, and pain catastrophizing were associated with worse scores on preoperative pain and performance measures. These are pain-related responses surgeons should consider when assessing patients before knee arthroplasty. TKA candidates found to have these pain responses may be targets for treatments that may improve postoperative outcome given that these responses are modifiable. Future intervention-based research should target this trio of maladaptive pain responses to determine if intervention leads to improvements in postsurgical health outcomes. LEVEL OF EVIDENCE: Level I, prognostic study.


Assuntos
Adaptação Psicológica , Artralgia/psicologia , Catastrofização , Comportamento de Doença , Osteoartrite do Joelho/psicologia , Percepção da Dor , Idoso , Artralgia/diagnóstico , Artralgia/fisiopatologia , Artralgia/cirurgia , Artroplastia do Joelho , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia , Medição da Dor , Limiar da Dor , Medidas de Resultados Relatados pelo Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Estados Unidos , Teste de Caminhada
11.
Br J Cancer ; 116(12): 1638-1642, 2017 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-28463963

RESUMO

BACKGROUND: Appraisal delay (AD) refers to the time interval between onset of symptoms and the date a patient first seeks healthcare. Because studies have shown that individuals who are overweight or obese may delay or avoid seeking healthcare due to stigma, this study aims to investigate the role that weight plays in AD among symptomatic individuals subsequently diagnosed with colorectal cancer (CRC). METHODS: Structural equation modelling tested the relationship between AD, body mass index (BMI), financial barriers, cognitive barriers, and reported symptoms among 179 newly diagnosed CRC patients in two U.S. healthcare systems. RESULTS: BMI was directly and significantly related to AD (ß=0.10; P=0.044) and to cognitive barriers (ß=0.24; P=0.005). Cognitive barriers were direct and significant predictors of increased AD (ß=0.32; P=0.000). Symptom experience and financial barriers were mediated through cognitive barriers. CONCLUSIONS: Model results support the hypothesis that increased BMI is significantly and directly associated with increased AD and key cognitive barriers relevant to care-seeking behaviour.


Assuntos
Índice de Massa Corporal , Neoplasias Colorretais/diagnóstico , Diagnóstico Tardio/psicologia , Modelos Teóricos , Obesidade/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Idoso , Peso Corporal , Estudos Transversais , Medo , Feminino , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade
12.
Health Qual Life Outcomes ; 15(1): 232, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-29191188

RESUMO

BACKGROUND: A patient's recovery expectations prior to knee arthroplasty influence postsurgical outcome and satisfaction but a unidimensional measure of expectation has not been reported in the literature. Our primary purpose was to determine the extent to which a patient expectations scale reflects a unidimensional construct. Our second purpose was to identify pre-operative variables associated with patients' expectations. We hypothesized that previously identified predictors of the latent expectation scale score would be associated with expectations and that previously unexplored variables of pain catastrophizing, depressive and anxiety symptoms, self-efficacy and number of painful body regions would also associate with pre-operative expectations. METHODS: Our randomized clinical trial had 384 patients assessed prior to knee replacement surgery. The expectations scale along with several predictor variables including WOMAC, psychological distress, and sociodemographic variables were obtained. Confirmatory factor analysis tested the unidimensionality of the measure and structural equation modeling identified predictors of the latent expectations measure. RESULTS: The expectations scale was found to be unidimensional with superior model fit (χ2 = 1.481; df = 2; p = 0.224; RMSEA = 0.035; 90% CI = [0-0.146]; CFI = 0.999; TLI = 0.993). The only variable significantly associated with expectations in the multivariate model was self-efficacy. CONCLUSIONS: The expectations scale used in our study demonstrated unidimensionality and has strong potential for clinical application. Poor self-efficacy is a potential target for intervention given its independent association with expectation. Addressing expectations directly and indirectly through self-efficacy assessment may assist in better aligning patient's expectations with likely outcome. TRIAL REGISTRATION: ClinicalTrials.gov NCT01620983 .


Assuntos
Artroplastia do Joelho/psicologia , Satisfação do Paciente , Qualidade de Vida , Autoeficácia , Idoso , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Período Pré-Operatório , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Inquéritos e Questionários , Resultado do Tratamento
13.
Aging Ment Health ; 21(4): 399-408, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-26488225

RESUMO

OBJECTIVES: This study used latent growth curve modeling (LGCM) to estimate the independent and joint associations between frailty and depression trajectories and likelihood of nursing home admission and falls resulting in injury. METHODS: Data come from five waves (2004-2012) of the Health and Retirement Study. Community-dwelling individuals aged 51 and older (N = 13,495) were analyzed using LGCM. Frailty was measured using a frailty index consisting of 30 deficits. Depressive symptoms were measured using the eight-item Centers for Epidemiologic Studies - Depression scale. Adverse health outcomes included nursing home admissions and falls resulting in injury. RESULTS: Prevalence of frailty increased over the study period (24.1%-32.1%), while the prevalence of depression was relatively constant over time (approximately 13%). Parallel process LGCM showed that more rapid increases of frailty and depressive symptoms were associated with higher odds of both nursing home admission and serious falls over time (Frailty: ORNursinghome = 1.33, 95% CI: 1.09-1.66; ORFall = 1.52, 95% CI: 1.12-2.08; Depression: ORNursinghome = 3.63, 95% CI: 1.29-9.97; ORFall = 1.16, 95% CI: 1.01-1.34). Associations between frailty and adverse outcomes were attenuated, and in some cases were no longer statistically significant, after accounting for concurrent depression. CONCLUSION: Frailty trajectories may be important indicators of risk for nursing home admissions and falls, independent of baseline frailty status; however, concurrent depression trajectories are associated with adverse outcomes to a similar degree as frailty. Focus should be given to distilling elements of the frailty index which confer most risk for poor health outcomes.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Transtorno Depressivo/epidemiologia , Idoso Fragilizado/estatística & dados numéricos , Avaliação Geriátrica/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Avaliação Geriátrica/métodos , Instituição de Longa Permanência para Idosos , Humanos , Masculino , Pessoa de Meia-Idade , Casas de Saúde , Fatores de Risco , Estados Unidos/epidemiologia
16.
Arch Womens Ment Health ; 19(5): 769-78, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-26802021

RESUMO

UNLABELLED: The aim of this study was to characterize latent subtypes of major depression and changes in these subtypes among women receiving citalopram in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. Latent transition analysis was applied to data from 755 women who completed baseline and week 12 study visits in level 1 of STAR*D. Items from the self-report version of the Quick Inventory of Depressive Symptomatology were used as indicators of latent depression subtype. Four subtypes were identified at baseline and week 12. The baseline subtypes were Mild (21 %), Moderate (30 %), Severe with Increased Appetite (16 %), and Severe with Decreased Appetite (34 %). The subtypes at week 12 were Symptom Resolution (65 %), Mild (23 %), Moderate (9 %), and Severe with Psychomotor Disturbances (3 %). Women in the Moderate subtype at baseline had the greatest chance of moving to Symptom Resolution (87 %). Women in the Severe with Decreased Appetite subtype had the lowest chance of transitioning to Symptom Resolution (46 %). Depression severity and appetite distinguished depression subtypes for women before treatment with citalopram. Depression severity and psychomotor disturbances characterized the subtypes after treatment. This work highlights the need to consider how depression treatment changes different symptoms instead of relying exclusively on summary rating scores. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov , NCT00021528.


Assuntos
Antidepressivos de Segunda Geração/uso terapêutico , Citalopram/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/fisiopatologia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Agitação Psicomotora , Autorrelato , Adulto Jovem
17.
Clin Orthop Relat Res ; 473(11): 3527-34, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25701000

RESUMO

BACKGROUND: Preoperative depressive symptoms have been shown in some but not all studies to be associated with poor self-reported pain and function outcomes. In addition, depressive symptoms after surgery have been shown to improve relative to preoperative levels. QUESTIONS/PURPOSES: We hypothesized that (1) preoperative depressive symptoms would predict postoperative pain; (2) depressive symptoms would decrease after surgery; and (3) preoperative depressive symptoms would increase as the scheduled surgery date approached. METHODS: Data from the Osteoarthritis Initiative, a National Institutes of Health-funded prospective multiyear cohort study, were used in this retrospective analysis. Persons from four communities were eligible if they had radiographic knee osteoarthritis or were at risk for developing knee osteoarthritis based on occupational, medical history, or body weight risk factors. A total of 4796 persons participated and rates of followup were 80% or greater over the course of the study. Participants completed a validated depressive symptom scale and the Knee Injury and Osteoarthritis Outcome Scale pain scale each year for 3 years before and 3 years after TKA. Latent growth curve modeling was used to model intercepts and slopes of pre- and postoperative depression and pain. Preoperative trajectories and intercepts were then used to predict postoperative pain and depressive symptoms adjusting for confounding variables. RESULTS: After adjustment for potential confounding, we found no evidence that preoperative depressive symptoms predicted postoperative pain with function (estimate, 0.1; 95% confidence interval, -0.31 to 0.50; p = 0.64) or that depressive symptoms were reduced after surgery (z = 0.06, p = 0.80). We also found no evidence to indicate that preoperative depressive symptoms increased as the date of surgery approached (linear slope = 0.28, SE = 0.19, p = 0.15). CONCLUSIONS: Preoperative and postoperative depressive symptoms in patients before and after TKA did not appreciably change over a 6-year perioperative period. Patient depressive symptoms were not reduced after surgery and did not appear to be related to less pain postoperatively. Our findings of no association between preoperative depressive symptom severity and postoperative pain and no reduction in postoperative depressive symptoms run counter to other available evidence, potentially attributable, in part, to a data collection process that occurred outside of orthopaedic surgeons' offices. Future research is needed to more fully explore the potential role of social desirability, the concept that patients respond in a way that they think the researcher or clinician wants them to respond in lieu of responding in a way that truly reflects the patient's status. Social desirability may influence a TKA patient's pain and function outcome assessment. LEVEL OF EVIDENCE: Level I, prognostic study.


Assuntos
Artralgia/cirurgia , Artroplastia do Joelho/psicologia , Depressão/psicologia , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Dor Pós-Operatória/psicologia , Idoso , Idoso de 80 Anos ou mais , Artralgia/diagnóstico , Artralgia/fisiopatologia , Artralgia/psicologia , Artroplastia do Joelho/efeitos adversos , Fenômenos Biomecânicos , Depressão/complicações , Depressão/diagnóstico , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/psicologia , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
18.
Psychooncology ; 23(9): 981-8, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24615789

RESUMO

OBJECTIVE: To evaluate the relationship between symptoms, financial and cognitive barriers with patient delays in seeking evaluation of symptoms. METHODS: Data were collected from 252 colorectal cancer patients from academic and community oncology practices in Virginia and Ohio. We used a cross-sectional, mixed methods design collected data through patient interviews and medical record reviews. Structural equation modeling (SEM) tested the hypothesized relationships between symptoms, financial and cognitive barriers and patient care seeking delays. RESULTS: In bivariate analyses, patients who reported a financial barrier to accessing health care (t (246) = -2.6, p < 0.01) were more likely to have greater care-seeking delays. Model testing revealed that experiencing cognitive barriers was a significant, positive, direct predictor of appraisal delay (0.35; p < 0.01). Indirect pathways from symptoms (0.07; p < 0.05) and financial barriers (0.09; p < 0.05) to appraisal delay via cognitive barriers were significant. CONCLUSIONS: Patient interpretations of symptoms were influenced by financial barriers. Conceptualizing financial barriers as a component of the symptom appraisal process is conceptually different from viewing it as only a structural barrier preventing healthcare access. Implications for practice These findings extend our understanding of why and how patients seemingly ignore serious symptoms, which hamper physician ability to provide curative therapy. In addition to uninsured patients, this may have important implications for the treatment and care of those who are underinsured.


Assuntos
Neoplasias Colorretais/diagnóstico , Diagnóstico Tardio/economia , Conhecimentos, Atitudes e Prática em Saúde , Acessibilidade aos Serviços de Saúde/economia , Aceitação pelo Paciente de Cuidados de Saúde , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/terapia , Estudos Transversais , Detecção Precoce de Câncer/psicologia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Ohio , Fatores Socioeconômicos , Fatores de Tempo , Virginia
19.
Arthritis Rheum ; 65(12): 3304-13, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23983118

RESUMO

OBJECTIVE: To determine the trajectories of preoperative worsening and postoperative recovery for both the index knee and the contralateral knee of patients undergoing knee replacement surgery. METHODS: Of the 4,796 subjects in the Osteoarthritis Initiative cohort study database, we examined 5-year data from 177 patients who underwent isolated unilateral knee replacement surgery and no other joint replacement surgery. Patient-reported outcomes captured domains defined by the International Classification of Functioning, Disability, and Health. Domains of knee structure and function, activity limitation, and participation restriction were examined using growth-curve modeling over 5-year periods prior to and following surgery. RESULTS: Preoperative worsening of the index knee was substantial in all domains of knee impairment, activity limitation, and societal participation. Pain intensity worsened only slightly from 5 years to 2.5 years prior to surgery, but worsened by ∼2 points (0-10-point scale) during the 2.5 years prior to surgery. Trajectories of improvement following surgery varied depending on the outcome measure. The contralateral knee also changed over time, such that by ∼2 years following surgery, pain was worse and by 3 years, activity limitation was worse in the contralateral knee as compared to the index knee. CONCLUSION: Patients who elect to undergo knee replacement surgery demonstrate perioperative trajectories of change that influence most health domains for both the index knee and the contralateral knee. After a period of no change, escalation of pain and worsening functioning in the index knee begins ∼2.5 years prior to surgery, which may be a key trigger for surgery.


Assuntos
Artroplastia do Joelho/métodos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Recuperação de Função Fisiológica/fisiologia , Idoso , Estudos de Coortes , Avaliação da Deficiência , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Medição da Dor , Período Pós-Operatório , Resultado do Tratamento
20.
J Health Commun ; 19 Suppl 2: 205-24, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25315594

RESUMO

Health literacy is related to a broad range of health outcomes. This study was designed to develop a psychometrically sound instrument designed to measure cancer health literacy along a continuum (CHLT-30), to develop another instrument designed to determine whether a patient has limited cancer health literacy (CHLT-6), and to estimate the prevalence of limited cancer health literacy. The Cancer Health Literacy Study involving 1,306 Black and White cancer patients was conducted between April 2011 and April 2013 in the Virginia Commonwealth University Massey Cancer Center and surrounding oncology clinics. A continuous latent variable modeling framework was adopted to dimensionally represent cancer health literacy, whereas discrete latent variable modeling was used to estimate the prevalence rates of limited cancer health literacy. Self confidence about engaging in health decisions was used as the primary outcome in external validation of new instruments. Results from a comprehensive analysis strongly supported the construct validity and reliability of the CHLT-30 and CHLT-6. For both instruments, measurement invariance tests ruled out item/test bias to explain gender and race/ethnicity differences in test scores. The limited cancer health literacy rate was 18%, a subpopulation consisting of overrepresented Black, undereducated, and low-income cancer patients. Overall, the results supported the conclusion that the CHLT-30 accurately measures cancer health literacy along a continuum and that the CHLT-6 efficiently identifies patients with limited cancer health literacy with high accuracy.


Assuntos
Avaliação Educacional/métodos , Letramento em Saúde/estatística & dados numéricos , Neoplasias , Adolescente , Adulto , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/etnologia , Pobreza , Psicometria , Reprodutibilidade dos Testes , Autoimagem , Virginia , População Branca/psicologia , População Branca/estatística & dados numéricos , Adulto Jovem
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